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Published on: February 22, 2013
Clinical features, risk factors, and outcome of cerebral venous thrombosis in Tehran, Iran
Samira Yadegari1, Askar Ghorbani2, S Roohollah Miri3
1Department of Neuro-ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Underlying diseases, not oral contraceptive pills, were the most common cause of cerebral venous sinus thrombosis (CVST). Many patients had multiple risk factors, highlighting the need for thorough investigation in CVST diagnosis.
Area of Science:
- Neurology
- Radiology
- Internal Medicine
Background:
- Cerebral venous sinus thrombosis (CVST) is often under-diagnosed despite advances in magnetic resonance imaging (MRI).
- Assessing risk factors in CVST patients is crucial for diagnosis and management.
Purpose of the Study:
- To characterize the frequency and types of risk factors associated with CVST.
- To analyze clinical presentation, diagnostic findings, and outcomes in CVST patients.
Main Methods:
- Retrospective analysis of 53 patients diagnosed with CVST via MRI and MR venography over six years.
- Data collected included clinical symptoms, medical history, thrombophilic profile, D-dimer levels, and neuroimaging findings.
Main Results:
- The most frequent risk factor identified was an underlying disease (21 patients), contrasting with oral contraceptive pill (OCP) use.
- Headache and papilledema were common symptoms; 36% of patients had multiple contributing factors.
- Mortality was 3.7%, with focal neurologic deficit and cranial nerve palsy predicting poor outcomes.
Conclusions:
- Underlying diseases are a more prevalent cause of CVST than OCPs in this cohort.
- The frequent occurrence of multiple risk factors necessitates comprehensive diagnostic workups for CVST.
Introduction:
Despite increasing the use of magnetic resonance imaging (MRI), cerebral venous sinus thrombosis (CVST) has remained an under-diagnosed condition. In this study, characteristics and frequency of various risk factors of CVST patients in a tertiary referral hospital were closely assessed.
Methods:
Patients with an unequivocal diagnosis of CVST confirmed by MRI and magnetic resonance venography during 6 years of the study were included. All data from the onset of symptoms regarding clinical signs and symptoms, hospital admission, seasonal distribution, medical and drug history, thrombophilic profile, D-dimer, neuroimaging, cerebrospinal fluid findings, mortality, and outcome were collected and closely analyzed.
Result:
A total of 53 patients with female to male ratio of 3.07 and mean age of 33.7 years were included in the study. Headache and papilledema were the most frequent clinical features (44 and 36 patients, respectively). An underlying disease (diagnosed previously or after admission) was the most common identified risk factor for CVST in both females and males (21 patients). A total of 15 women used the oral contraceptive pill (OCP) where 12 of them had simultaneously other predisposing factors. Overall, 19 patients (36%) had more than one contributing factor. D-dimer had a sensitivity of 71.4% in CVST patients. The mortality of patients in this study was 3.7% (n = 2). Focal neurologic deficit and multicranial nerve palsy were associated with poor outcome which defined as death, recurrence, and massive intracranial hemorrhage due to anticoagulation (P = 0.050 and 0.004, respectively).
Conclusion:
Unlike most of the CVST studies in which OCP was the main factor; in this study, an underlying disease was the most identified cause. Considering the high probability of multiple risk factors in CVST that was shown by this study, appropriate work up should be noted to uncover them.
